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I - Please " ertype,(Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4 Marl'Tracking t T acking Number WASTE MANIFEST r-., ;;yL7??r .• V 3 FLE 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Lyon ESP LID (i_5700p��Auru�3 Gene— gator Ohorne� 6. Transporter 1 Company Name U.S. EPA ID Number :'idiammai Chermi TrlwTwst Ntc. : ' CAROIM7d540 7. Transporter2 Company Name. U.S. EPA ID Number 8 Designated Facility Name and Site Address U.S. EPA ID Number Lis dei t10 PO Box�F G� 11 1+61ss S Beatty NV f334U10 Q Facility's on� 77S55.4,?M ga. 9b. U.S. DOT Description (including Proper Shipping Name. Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13, Waste Codes HM and Packing Group (If any)) No. Type Quantity Wtivol, o x 1VA307T HaraiBnes Waste Soiir3s, N_O.S. (Hari , 9. PCr`: p OdDb 187 J 2. 4443Vl7tyAqleq . kois s44 !sty :a� ��u� n .. iisr �� p ! 8 D00711011 co DA A90 - K4q { 414kfc bl Lvii sot I a cal � SDI r � a. I 14. Special Handling Instructions and Additional Information PUMASOW 154778 ._,. , 1) a7012&1014517YCRUP 01) 1- +0 / W3 -6900 ! `pq� �(Sj..:. 15. GENERATOR'S/OFFEROR'S CERTIFICATION: IIfereby declare that the contents of thisrunsiAnment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/Placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. if export shipment and I am the Primary Exporter. I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. Icertify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. General 'srOffero s P ' tetlfiyped Name - Signature �JMonth Day . eat •�!l ^x 'C df- iso // '— '� .�.,,..��" E lu• 16International Shipments El Import to U.S. ❑ 1h17 i p Export fro S. Port of entrylext Transporter signature (for experts only): Date leaving U.S Cic W 17. Transporter Acknowledgment of Receipt of terials f _ T a r1 rinteClTyped Nyme I gn r Mon e M Ud Id�j I , W Transporter Prinled(Typetl NameSignature UMonth Day Year F 18. Discrepancy t 18a, Discrepancy Indication Space ❑ Quantity Type Residue y ❑ ❑ Partial Rejection El Full Rejection ❑ Manifest Reference Number: 186. Alternate Facility (or Generator) U.S. EPA ID Number - LL Facility's Phone: 18c. Signature of AAernate Facility (or Generator) Month Day Year a z a—i 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 3. - _- _ - . 4. 20 Designated Fac l ty Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted n Item 18a Prnteo iyped.Name signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR